The health care journey is changing. Patients require care that is “coordinated, convenient, customized, and accessible”. What is the existing post-engagement strategy for managing a patient post-clinic?

The key to any successful post-clinic care strategy is listening and engaging patients on the paths they decide. Each of us is adherent to plans we create and direct. By asking the patient to respond to good care plan choices, the patient can self determine their own path. The best design? Care paths the provider knows are clinically beneficial, that creates patient choice; co-producing health and enhancing relationship.

As suggested by Leslie in the discussion of design, key ROI strategies require patient involvement in the process whether specific treatment or ongoing management. There are so many things outside a patients control, they can understandably become frustrated with it all, and uninvolved leaving the Provider ill informed (sorry about the pun). So strategies and technology that easily allow patients to be more proactive and informed, perhaps in direct partnership with the Provider, have shown improved results in areas such as patient satisfaction, quality of care and outcomes

In specific regard Gary to your question on post engagement strategy for post clinic, please let the worst thing that should be done (and done more often than we’d like to admit) is what I call “thanks for coming and read”. In other words patients are given tomes of documentation to read and follow for post care, and you know what happens to that. A strategy we provide our clients is the ability to allow technology to follow and work with the patient. Allowing patients to choose how they want to communicate, be educated as to needs and follow their progress. In many cases it’s as simple as using their mobile phone and text messaging, responding to message, and which in turn prompts other enquiries or dialogue. The end result is patients controlling how, and what, to when they are involved, realizing a sense of empowerment and not being overwhelmed. The outcome being improved adherence, and compliance to post clinical management, reducing discomfort, complications and readmissions

I love discussions that use the term ROI. There is unquestionably margin for improved patient engagement. What concrete patient-first strategies have netted ROI, driving measurable improvements? Are there examples with quantifiable ROI?

Ah yes, the ROI question … It’s a tough one, not only on looking at the quantifiable areas to measure as there are so many elements involved in the health eco-system, but also what ROI is valuable? More specifically, we have found that different clients value different ROI’s differently. As an example, in the VA for example, in one of the our utilizations in PTSD we “saved” a facility approx. $1.4Million per year based on a 32% reduction in re-admissions. And as good a monetary measurement as that was, a more meaningful ROI on that group was that the reduction in re-admissions allowed 38 more Vets to get access than had previously. In another case, a client utilizing our communication platform was able to change the metrics on clinician to patient in a maternal care program from 1 clinician to 5 patients to 1 clinician to 150 patients. The clinicians were still managing 25 patients, but now they were managing those who needed their more immediate care (based on our clients rules) and when asked, almost 100% of the patients thought they were now getting better care.

Many more examples, but key to this illustration is understanding what ROI is meaningful to your client AND their population

Well said, Howard. Add to this the shifting reimbursement, many get hung up on this question. When patients bring operational efficiency to a healthsystem, then regardless of the payment model, there is ROI. This is a largely untapped area, where there is little “evidence”. However smart organizations will build in expected savings and measures in any system or process implementation.

Another area rarely talked about is the ROI to the patient. Imagine a patient able to know when and where to get cost effective care. They would choose it. Patients with tools able to self-triage can make better decisions about their care and expected cost. Both are important.

To your question Gary, “With patient-centric strategies and reduction in re-admissions using smarter communication tools could this drop further?” The answer is a resounding “yes” in that these figures would include very little, if any, patient centric tools. And if you were to imagine these solutions adding solutions where the patients are more engaged, reduce costs associated with going to a physician/clinic (such as interacting from home to avoid unnecessary travel or clinic time) or a clinic/surgery (pre-triage/prep to ensure all is ready), re-admissions (on-going dialogue to help with management/therapy), chronic issues (helping to manage or de-escalate complications)

In the early days of readmission measure development, I heard testimony as part of the National Quality Forum readmission measure committee. This testimony from the healthsystem providers indicated that as much as 45% of the reasons for readmission was out of the control of the hospital. These were things like, non-adherence to follow-up appointments with the primary care doctor, adherence and access to medications needed, lack of transportation, family support and other social determinants that impact health. In each of these areas communication with the patient that encourages and engages the patient to help get needed care and support will absolutely reduce readmissions. There can be significant cost implementing this communication with a traditional methods like health navigators, social workers and other staff. In this traditional model the costs of the readmission program is overwhelming. Using technology that is low cost, easy to implement and uses no new technology for the patient or the provider that is scalable is ideal